Sophie McCoid and Anna Templeton discuss recent findings showing 54% of GPs want the power to deny non-emergency treatment to those who won’t lose weight or quit smoking

Cream cakes and nicotine versus penicillin and surgery: it is common sense where our health priorities should lie.Yet the media criticised 54% of GPs who said the NHS should have the right to withhold treatment to obese or nicotine-addicted patients.

The increasing population and cuts to public healthcare mean that controversial health issues such as this will become more and more frequent, so it is vital that some sort of resolution is achieved.

Fact: public sector net debt at the end of March 2012 was £1022.5 billion, and the NHS is under increasing pressure as a result of the cuts the government are making. However, demand for healthcare is exceeding existing resources, meaning that some form of rationing is entirely necessary.

With the case of treatment, who gets priority? It appears that there are only two options: number one would work on a first come, first served basis. This appears fair, but doesn’t take into account the patients who are most in need.

Number two would be on the basis of those who need and deserve it the most. Does a ‘textbook’ healthy patient, who contracts an illness purely by coincidence, not deserve priority treatment over a 40-a-day obese smoker?
Obesity is currently costing the NHS £6 billion per year, whilst smoking-related illnesses similarly cost £2.5 billion. Therefore, the financial burdens of the NHS may be why doctors feel there is more justice in treatment favouring those who lead healthier lifestyles.

Doctors are not suggesting that they will refuse to treat the morbidly obese or regular smokers, but that patient prioritisation is made against the backdrop of NHS debt.

Surely we (the ones who rely on free healthcare) trust our doctors’ medical opinions to decide what is best for us. If a doctor decides that being a regular smoker or being morbidly obese would hinder surgical survival chances, then maybe the denial of treatment seems justified.
In the same way, if an obese person goes through bariatric surgery, only to put weight back on, does a doctor not have the right to refuse repeat surgery?

It is easy to get overly ‘medically-ethical’ on a subject such as this, saying that doctors are shifting to some form of Darwinian view.However, if people continue to rely on the NHS for easy treatment of their problems instead of tackling more intrinsic emotional or psychological reasons, we will turn into a state where the NHS is taken for granted. We may have a system of publicly funded healthcare, but this irrefutably should not translate into the abandonment of a healthy lifestyle.

Imagine living in a society where if you were obese, a smoker or (God forbid) both, you would be denied free medical treatment. Purely because you were overweight and/or hooked on nicotine you could be denied IVF treatment amongst other procedures. As dystopian as this society sounds, if 54% of doctors had their way this would become common practice in the UK.

Doctors were asked by professional networking site doctors.net.uk: ‘Should the NHS be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking?’ Alarmingly the majority of doctors answered ‘yes’, something that disturbs me greatly.

Medical professionals have defended their decision to deny treatment to smokers and the obese because treatment can be more difficult and less likely to work on these two groups. This may be the case but surely just because something has less chance of working doesn’t mean you shouldn’t try to alleviate the problem at all.

In these times of austerity some in the NHS believe that they shouldn’t be obliged to ‘waste’ resources on those who are ‘undeserving’. Whilst budgets need to be met and cutbacks made this should not be at the expense of patients’ health. The NHS was made to provide free healthcare to all UK citizens, putting in place these proposals this would be going against everything the NHS stands for and is a step on a very slippery slope.

Denying someone treatment that really needs it just because they made a poor lifestyle choice is simply morally and ethically wrong. I think it is acceptable for doctors to advise people to alter their habits before an operation is due to take place but if they try and fail to change their lifestyle it is my view that they should still be allowed the operation they require.
Smokers and obese individuals are already being denied operations such as hip or knee replacements. Indeed, the medical magazine Pulse found that 25 of 91 primary care trusts had introduced treatment bans for those groups since April 2011.

This trend in my view is highly worrying and begs the question: when will doctors begin to think that refusing to provide emergency treatment to smokers and the obese is acceptable? And how long before other people who make bad lifestyle choices such as drug addicts and alcoholics are also refused NHS treatment.

The Royal College of Physicians, which represents hospital doctors, agrees with me and opposes the practice stating: “Lifestyle rationing is creeping into the NHS. There are reported examples where treatments have been restricted by PCTs and we wouldn’t agree with that,” said Professor John Saunders, chair of the College’s ethics committees.

The Department of Health also finds the survey worrying: “There is no excuse to deny care on the basis of arbitrary blanket bans – the individual needs of patients must be taken into account” one spokeswoman said.
Whilst I believe smokers and obese people should attempt to change their lifestyle to improve their health and chance of operation success, they should not be denied treatment. Medical care is a basic human right in the UK and any lifestyle choice a person makes should ultimately not affect this.